Coordination - Istituto Superiore di Sanità, Roma


The National Register of Cardiovascular Disease is a surveillance system designed to monitor both fatal and non fatal coronary and cerebrovascular events in the general population ages 35-74 years. It is one of the Progetto Cuore lines of research.

 

Its main objective is to estimate the frequency of coronary and cerebrovascular events in eight geographically strategic and representative areas of the country: Brianza, Caltanissetta, Florence, Friuli-Venezia Giulia, Modena, Naples, Rome and Veneto. Data gathered under the coordination of the Istituto Superiore di Sanità are fed into the National Register.

 

The Register allows to obtain reliable estimates of the incidence, attack and fatality rates of coronary and cerebrovascular events; moreover, it clearly shows how often diagnostic and therapeutic procedures are used in the acute and post-acute phases in the North, Centre, South and Islands.

 

Methodologically, data collection is achieved using two sources of information: death certificates (ISTAT) and hospital discharge records (HDR). Combining the aggregate data from both sources, and monitoring the length of hospitalization, it is possible to identify suspect coronary and cerebrovascular events. A subsample of these events has been validated applying the procedures and diagnostic criteria of the MONICA project.

 

WHO-MONICA Project

The MONICA (MONItoring of CArdiovascular diseases) project was launched in the early 1980s in order to assess whether the decrease in the coronary heart disease death rate observed in several countries was real and, if so, how much of it had to be attributed to reduction in incidence and how much to reduction in fatality. To answer this question, the MONICA project, for a period of 10 years in 37 populations from 21 countries, used a standardized method to measure trends in the attack rate of coronary events and their fatality rate, as well as trends in acute phase treatment and in the risk factors distribution in the population under examination. In Italy, the areas involved in the project were situated in the North - Brianza area and Friuli area; a third area, the Latina area, located in the Centre, interrupted its monitoring activity after three years. Click on the links for the attack rate of coronary and cerebrovascular events and for the case fatality rate of coronary events.

 

Thanks to the MONICA project experience, simplified procedures were set up and today they still represent flexible public health instruments. These procedures, applied during a pilot study in several areas (Caltanissetta, Modena, Naples, Rome), produced satisfactory results, although barely comparable, as they were over-dependent on the diagnostic procedures used locally. Thus, this experience pointed to the need for standardization and validation systems to improve data comparability. Recently, two further areas have been added to the eight register areas - Florence and the Veneto Region, the latter in particular for the monitoring of cerebrovascular events.